When, if ever, would you select a three-drug regimen instead of four-drug regimen in patients with newly diagnosed Multiple Myeloma?

Thank you for this question. For older, transplant-ineligible patients, there is no data that patients live longer or better (the true goals of treatment) with four drugs instead of three drugs. Yes, the responses are better, and we hope this may translate to longevity over time, but we do not know ...

In the setting of a very frail older-aged adult with multi-pharmacy and several significant co-morbid conditions that would prohibit the use of certain medications. An example would be someone over the age of 75 yo with severe peripheral neuropathy at diagnosis, DRd (MAIA) would be tolerated better ...

Our institution has participated enthusiastically in ECOG protocol EAA181, which starts out with daratumumab, lenalidomide, and dexamethasone induction for 9 cycles, then a randomization to add in bortezomib for 9 additional cycles or not. The study was designed for patients who are transplant ineli...